Healthcare Nursing

Prelimenary Literature Review

The following discussion will evaluate five primary literature articles in regards to fatigue in cancer patients.  Each of these articles represents a modern research question impacting cancer patients experiencing fatigue as a symptom of this condition.

The article “An Intervention to Manage Patient-Reported Symptoms During Cancer Treatment” by Williams et al. (2011) references a pilot study in order to investigate the effects of nursing intervention geared towards patient education for symptom management for cancer patients undergoing therapy.   The study specifically evaluated symptom occurrence and severity.  The research was conducted using a control and study group and the control group received the standard care, while the study group received the educational intervention. The authors indicated that the study was approved by the institutional review board at the university cancer center; however, the specific name of the review board was not clearly named in the study. The authors described the study instruments that were used throughout the duration of the study.  For example, the TRSC patient self-report tool was used in order to rate 25 symptoms on a severity scale, while the Health-Related Quality-Of-Life Linear Analogue Self-Assessment was used in order as a scale to measure quality of life in the patients.  Finally, the Karnofsky Performance Status Scale and Health Form were implemented to enable nurses to rate the status of the patients receiving the cancer therapy.  The findings in this study illustrated that the participants in the intervention group (study group) experienced a decreased amount of symptom occurrence and severity rates compared to the control group.  Statistical analyses supported a significant difference in the TRSC data between the control group and study group for mean symptom occurrence and severity.  However, the KPS scores reported by the nurses were not statistically different between the intervention and control groups, and only slight variations were reported in the quality of life scores.

An article by Johnson et al. (2012) entitled “An Intervention to Manage Patient-Reported Symptoms during Cancer Treatment” was written as a guideline for clinicians working with cancer patients.  The guideline addresses cancer-related fatigue and recommendations for management in patients reporting this symptom.  The authors report that cancer-related fatigue is difficult to assess; however, they indicate that patient-reported outcomes have been successful in recognizing the prevalence of fatigue in these patients.  The authors reviewed the NCCN guidelines for managing cancer-related fatigue established in 1999 and 2011 and they describe which recommendations are appropriate based upon study evidence, such as patient education and counseling, exercise, distress management, medications, and mind-body interventions, including yoga.

An article by Hilarius et al. (2011) entitled “Cancer-related fatigue: clinical practice versus practice guidelines” considers a research study in order to evaluate the outcome of adherence to treatment guidelines for cancer-related fatigue and its association or correlation to the severity level of anemia.  The sample size in this study was large, with 136 cancer patients treated with chemotherapy as study participants.  These patients were required to complete a survey during their visits and indicate their level of fatigue, as well as the type of advice or counseling they had received. In order to address the anemia concern, hemoglobin levels were analyzed at each visit.  The results of this study illustrated that patients with less severe anemic conditions reported decreased levels of fatigue compared with patients exhibiting severe anemia.  In addition, it was indicated that over 50 percent of patients received fatigue counseling, with the majority of the counseling directed towards energy conservation.  Although the patients exhibiting severe anemia levels also reported fatigue, the study results did not show a significant correlation between fatigue and blood transfusion treatment.  Overall, the authors in this study suggest counseling patients as a guideline.

An article by Purcell (2010) entitled “Development of an educational intervention for cancer-related fatigue” also investigates cancer-related fatigue and education intervention.  However, the approach is different, as the authors describe the effectiveness of an education program known as the Cancer-Related Fatigue Intervention Trial (CAN-FIT).  In addition, the study evaluates the preliminary research regarding patients receiving radiotherapy.  The authors reviewed the program components, including education and support sessions, the handbook, follow-up phone calls, goal sheets and strategy tables.  The authors also describe the primary purpose of the support sessions, as well as the study methods, with two groups used in the pilot study and a total of nine study participants.  Each patient was given an evaluation form to complete after each session and the results indicated that the intervention received positive feedback from patients since they received new information and skills in order to better manage fatigue.  Overall, the authors indicated that the CAN-FIT program offers an education intervention that supports the improved management of cancer-related fatigue.

Finally, an article by Baservick (2010) entitled “Efficacy of an Intervention for Fatigue and Sleep Disturbance During Cancer Chemotherapy” was designed to investigate the efficacy of both energy and sleep enhancement intervention and their correlation to fatigue and sleep problems in order to increase the health status of cancer patients receiving therapy.  The study consisted of a control and study group, and all patients completed a questionnaire in order to provide an indication of sleep disturbance.  In addition, the patients were subject to an actigraphy to measure the total amount of sleep.  Fatigue was measured using the General Fatigue Scale. The intervention portion of the study consisted of telephone call follow-ups from the nurse. The results of the study indicated that there was no significant difference between control and variable patients.  The EASE intervention program did not aid in reducing fatigue or sleep disturbance.


Barsevick, A. Beck, S.L. Dudley, W.N., Wong, B., Berger, A.M., Whitmer, K., Newhall, T., Brown, S., and Stewart, K. (2010). Efficacy of an Intervention for Fatigue and Sleep Disturbance During Cancer Chemotherapy.  Journal of Pain and Symptom Management, 40(2), 200-216.

Hilarius, D.L., Kloeg, P.H., van der Wall, E., Komen, M., Gundy, C.M., and Aaronson, N.K. (2011).  Cancer-related fatigue: clinical practice versus practice guidelines.  Support Care Center, 19, 531-538.

Johnson, R.L., Amin, A.R., and Matzo M. (2012). Cancer-Related Fatigue Evidence-based recommendations for management.  American Journal of Nursing, 112(4), 57-60.

Purcell, A., Fleming,, J., Bennett, S., and Haines, T. (2010).  Development of an educational intervention for cancer-related fatigue.  British Journal of Occupational Therapy, 73(7), 327-333.

Williams, P.D., Williams, F., Lafaver-Roling, S., Johnson, Reness, and Williams, A.R., (2011).

An Intervention to Manage Patient-Reported Symptoms During Cancer Treatment.  Evidence-Based Practice.  Clinical Journal of Oncology Nursing  15(3), 253-258.